Individual
MYCAL L MANSFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
104 NICHOLAS PL, AVILLA, IN 46710-0069
(260) 897-3308
(260) 897-3650
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01067081A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000656884
ANTHEM
IN
05
—
200950300
—
IN
Enumeration date
05/17/2007
Last updated
10/17/2022
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